1、PUBLISHED DOCUMENTPD CEN/TR 15253:2005Health informatics Quality of service requirements for health information interchange ICS 35.240.80g49g50g3g38g50g51g60g44g49g42g3g58g44g55g43g50g56g55g3g37g54g44g3g51g40g53g48g44g54g54g44g50g49g3g40g59g38g40g51g55g3g36g54g3g51g40g53g48g44g55g55g40g39g3g37g60g3g
2、38g50g51g60g53g44g42g43g55g3g47g36g58PD CEN/TR 15253:2005This Published Document was published under the authority of the Standards Policy and Strategy Committee on 28 April 2006 BSI 2006ISBN 0 580 48178 6National forewordThis Published Document is the official English language version of CEN/TR 152
3、53:2005.The UK participation in its preparation was entrusted to Technical Committee IST/35, Health informatics, which has the responsibility to: A list of organizations represented on this committee can be obtained on request to its secretary.Cross-referencesThe British Standards which implement in
4、ternational or European publications referred to in this document may be found in the BSI Catalogue under the section entitled “International Standards Correspondence Index”, or by using the “Search” facility of the BSI Electronic Catalogue or of British Standards Online.This publication does not pu
5、rport to include all the necessary provisions of a contract. Users are responsible for its correct application. Compliance with a Published Document does not of itself confer immunity from legal obligations. aid enquirers to understand the text; present to the responsible international/European comm
6、ittee any enquiries on the interpretation, or proposals for change, and keep UK interests informed; monitor related international and European developments and promulgate them in the UK.Summary of pagesThis document comprises a front cover, an inside front cover, the CEN/TR title page, pages 2 to 32
7、, an inside back cover and a back cover.The BSI copyright notice displayed in this document indicates when the document was last issued.Amendments issued since publicationAmd. No. Date CommentsTECHNICAL REPORTRAPPORT TECHNIQUETECHNISCHER BERICHTCEN/TR 15253December 2005ICS 35.240.80English VersionHe
8、alth informatics - Quality of service requirements for healthinformation interchangeInformatique de sant - Exigences de qualit de servicepour les changes dinformation de santMedizinische Informatik - Anforderungen an die Service-Qualitt fr den Austausch von medizinischenInformationenThis Technical R
9、eport was approved by CEN on 13 November 2005. It has been drawn up by the Technical Committee CEN/TC 251.CEN members are the national standards bodies of Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France,Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,
10、 Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia,Slovenia, Spain, Sweden, Switzerland and United Kingdom.EUROPEAN COMMITTEE FOR STANDARDIZATIONCOMIT EUROPEN DE NORMALISATIONEUROPISCHES KOMITEE FR NORMUNGManagement Centre: rue de Stassart, 36 B-1050 Brussels 2005 CEN All rights of
11、exploitation in any form and by any means reservedworldwide for CEN national Members.Ref. No. CEN/TR 15253:2005: E2 Contents page Foreword 3 Introduction4 0 Scope .5 1 Structure of this document 5 2 References.6 3 Abbreviation7 4 Terms and definitions.8 5 Quality of service concepts9 6 Current relev
12、ant work in healthcare informatics standardisation.13 7 Typical healthcare QoS scenarios.14 8 Healthcare QoS categories.16 9 Development of ETG 021 Method 23 10 Summary and conclusions.25 Annex A Application of QoS concepts.29 CEN/TR 15253:20053 Foreword This Technical Report (CEN/TR 15253:2005) has
13、 been prepared by Technical Committee CEN /TC 251, “Health informatics“ the secretariat of which is held by NEN. This document has been developed by the Expert Group for Healthcare within the European Workshop for Open Systems (EWOS/EG MED). The editor of the document is Dr A J Kerr of Level-7 Ltd,
14、a member of EWOS/EG MED. Thanks are due to all who have contributed ideas, text and scenarios to assist in the production of this report. Special appreciation is expressed to Jeremy Tucker, who has provided liaison with the ISO/IEC JTC/1 QoS Group and provided much of the text for Clause 9. CEN/TR 1
15、5253:20054 Introduction Background This report considers user requirements for Quality of Service (QoS) specifically in the healthcare Information Technology (IT) environment. QoS is defined in 4 as: ”A set of qualities related to the collective behaviour of one or more objects.” Thus the definition
16、 is very broad, even when restricted to the healthcare IT environment. CR 12161 (EWOS/ETG 021): ”A Method for Defining Profiles for Health Care” 7 deals with the general categorisation of user requirements for healthcare information interchange. It assesses the suitability of profiles of standards f
17、rom the domains of Open Systems Interconnection / Open Systems Environment (OSI/OSE) to satisfy those user requirements. The method defined in CR 12161 was subsequently applied (by EWOS project team PT N024) to the specific domain of medical image interchange, and the findings were recorded in CR 12
18、069 (EWOS/ETG 045): ”Profiles for Medical Image Interchange” 8. In performing this work, a number of requirements were identified which could not adequately be mapped to the services provided by standardised OSI profiles. Some of these requirements could be considered as QoS issues. With this in min
19、d, the Healthcare Expert Group of the European Workshop for Open Systems (EWOS/EG MED) initiated a work item in May 1995 to identify QoS requirements for healthcare information interchange which need to be supported by standardised communications services. This report is the result of that activity.
20、 At the same time, international IT standards have been under development (by ISO/IEC JTC1/SC21 and ITU-T SG7) to define a QoS Framework 2 of terminology and concepts, in order to assist those wishing to specify or procure systems in which QoS is important, and to publish a Guide to QoS Methods and
21、Mechanisms 3, which is intended to be a source-book of references and widely-applicable mechanisms that can be used by systems designers and implementors. The scope of the activity is all forms of interaction between elements of distributed systems. The QoS work in ISO has been applied to the develo
22、pment of time-critical communications and to enhanced communications transport service and protocol (ECTS it includes the QoS requirements of information storage and processing IT systems. The related areas of security and financial cost considerations are not within the primary scope of the documen
23、t, although they are considered briefly. Of course, an informatics system with a high QoS does not guarantee a high standard of healthcare in terms of clinical outcomes or patient care. The quality of healthcare delivered to patients (the ultimate ”users”) depends upon a number of external factors s
24、uch as the experience and competence of the healthcare professional(s) or institution(s) involved. Potential QoS characteristics for the total healthcare delivery process such as mortality rate, clinical outcome, etc. are therefore not within the scope of this report. The report contains no provisio
25、ns to avoid the incorporation of bad or dangerous practice into healthcare IT systems. It is possible to circumvent good clinical practice with technical solutions which may cause bad practice. This vital issue is not covered by this report. To take an example scenario: A patient consults a doctor,
26、who takes a blood sample and arranges to see the patient again in two weeks. a) A “good“ practice doctor sees and reviews the blood test result as soon as it comes back from the laboratory and then files it if no action is required. b) A “bad“ practice doctor sees and reviews the blood test results
27、only when he reviews the patients case on the patients next visit. This case is not defensible if the patient has a preventable adverse event and takes legal action (source: MPS Casebook Summer 1997). The healthcare information system put into the medical practice in electronic form could build-in e
28、ither practice (a) or practice (b). This report does not consider the clinical quality assurance mechanism for the IT system. 1 Structure of this document Introduction - defines the scope and background of the work on QoS for Healthcare Information Interchange, and gives a list of references and acr
29、onyms. Clause 5 - Quality of Service Concepts - summarises QoS concepts from existing work. Clause 6 - Current Relevant Work in Healthcare Informatics Standardisation - provides a brief survey of known work related to QoS requirements and mechanisms in the international healthcare community. Clause
30、7 - Typical Healthcare QoS Scenarios- defines a number of User Scenarios demonstrating situations in which QoS is of importance. Clause 8 - Healthcare QoS Categories- draws together QoS requirements in the Healthcare sector, derived from the examples in Clause 7, and from elsewhere. It gives some gu
31、idance on what solutions may be appropriate. Clause 9 - Development of ETG 021 Method - considers how the ”Method for Defining Profiles for Health Care” defined in 7, and used in 8 and 9, might be extended to cover QoS requirements. Clause 10 - Summary and Conclusions - summarises the main points of
32、 the document and provides recommendations on how to proceed. Annex A - Application of QoS Concepts - contains examples of applications of the concepts in Clause 5, including aspects such as QoS in OSI and QoS in time-critical communications, in order to provide background information for the discus
33、sion of Attributes in Clause 9. CEN/TR 15253:20056 2 References 2.1 Primary references 1 ISO/IEC 7498-1:1994, Information technology - Open Systems Interconnection - Basic Reference Model: the Basic Model 2 ISO/IEC 13236:1998, Information technology Quality of service Framework ITU-T Recommendation
34、X.641 3 ISO/IEC TR 13243:1999, Information technology Quality of service - Guide to methods and mechanisms ITU-T Recommendation X.642 4 ISO/IEC 10746-2:1996, Information technology - Open Distributed Processing - Reference Model: Foundations ITU-T Recommendation X.902 5 RFC 1821 Integration of Real-
35、time Services in an IP-ATM Network Architecture, Borden et al (August 1995) 6 CEN/TC 251 Directory of the European Standardisation Requirements for Healthcare Informatics and Telematics - Programme for the Development of Standards. Version 2.1 (1996-08-15) 7 EWOS/ETG 021 (CR 12161:1995), A method fo
36、r defining profiles for healthcare 8 EWOS/ETG 045 (CR 12069:1995), Profiles for medical image interchange 9 EWOS/ETG 068 Multimedia Medical Data Interchange 10 IEEE Std 1073-1996, IEEE Standard for Medical Device Communications - Overview and Framework 11 Metz CE 1986, ROC methodology in medical ima
37、ging. Investigative Radiology 21:720-733 12 ISO/IEC 11172, Information technology - Coding of moving pictures and associated audio for digital storage media at up to about 1,5 Mbit/s (MPEG-1) 13 ISO/IEC DIS 13818, Information technology Generic coding of moving pictures and associated audio informat
38、ion (MPEG-2) 14 IEEE Std 1073.3.1-1994, IEEE Standard for Medical Device Communications - Transport Profile - Connection Mode (ANSI) 2.2 Supplementary references The following references may also be of interest to the reader: ISO 13485 Medical devices - Quality management systems Requirements for re
39、gulatory purposes ISO 13488 Quality systems Medical devices Particular requirements for the application of ISO 9002 Papers on QoS by Klara Nahrstedt, which can be found at the University of Illinois Department of Computer Science WWW site: http:/cs.uiuc.edu/CS_INFO_SERVER/DEPT_INFO/CS_FACULTY/FAC_HT
40、MLS/nahrstedt.html CEN/TR 15253:20057 3 Abbreviation BCC Bedside Communication Controller CL Connectionless CLNS Connectionless Network Service CO Connection Oriented CT Computed Tomography DCC Device Communication Controller DIS Draft International Standard DTR Draft Technical Report ECG Electrocar
41、diogram ECTS and it is classified into QoS requirements (if it expresses a requirement for QoS) and QoS data (if it does not) ISO/IEC 13236:1998 2 4.5 QoS parameter QoS information that is conveyed between entities as part of a QoS mechanism; parameters are classified into requirement parameters and
42、 data parameters; the information conveyed may relate to one or more QoS characteristics ISO/IEC 13236:1998 2 4.6 QoS management any set of activities performed by a system or communications service to support QoS monitoring, control and administration (as distinct from general techniques such as OS
43、I management) ISO/IEC 13236:1998 2 CEN/TR 15253:20059 4.7 QoS agreements the term level of agreement is sometimes used to refer to the negotiated level of support for a given set of QoS characteristics ISO/IEC 13236:1998 2 4.8 attribute property of a real-world object which can be characterised by a
44、 finite set of discrete values CR 12161:1995 7 4.9 Set of Attribute Values (SAV) for a defined set of attributes corresponding to a particular domain of interest (e.g. information interchange), the SAV consists of an (ordered) list of values for each attribute CR 12161:1995 7 4.10 Goodness of Fit Fa
45、ctor (GOFF) this defines how well a particular information processing solution (such as a profile) matches a particular SAV CR 12161:1995 7 4.11 user scenario description of a real-world information processing requirement, which may be characterised by a Set of Attribute Values CR 12161:1995 7 5 Qua
46、lity of service concepts 5.1 Sources The material in this clause is based on the QoS activity being undertaken by a Joint Rapporteur Group of ITU-T SG7 and ISO/IEC JTC1/ SC21/WG7, which was established in order to provide common guidance to any groups developing specifications relating to QoS. The f
47、irst objective of the QoS Group was to produce a QoS Framework standard, the aim of which is to provide a consensus set of concepts and terminology that will enable all those who are developing QoS specifications to adopt common approaches, to benefit from each others work and to communicate effecti
48、vely. This standard is currently an International Standard 2. In parallel, the Group has been documenting references to QoS specifications in various standards and other documents, as well as the details of a number of mechanisms for use with QoS that are believed to be widely-applicable. These will
49、 be published in a Technical Report, the QoS Guide to Methods and Mechanisms 3. The QoS Group is also specifying how QoS concepts can be incorporated into ODP (Open Distributed Processing) and the Object Management Architecture (OMA) of the Object Management Group (OMG). 5.2 Fundamental concepts 5.2.1 General The fundamental objective of any specification, implementation choice or mechanism relating to QoS can be expressed using three concepts: the management o
